Japanese Journal of Clinical Oncology 30:65-67 (2000)
© 2000 Foundation for Promotion of Cancer Research
Ultrasound-guided Core Needle Biopsy for Breast Cancer: Preliminary Report
1Second Department of Surgery and 2Department of Radiology, Tokyo Medical and Dental University, School of Medicine, Tokyo, Japan
 |
ABSTRACT |
|---|
 TOP ABSTRACT INTRODUCTIONPATIENTS AND METHODSRESULTSDISCUSSIONREFERENCES |
|---|
Background: Ultrasound-guided automated percutaneous core needle biopsy (US-CNB) for breast tumors has been introduced into clinical practice, but it has not yet been used routinely. We evaluated its usefulness, especially in terms of histological accuracy.
Methods: Thirty-one consecutive patients underwent mammography followed by breast biopsy with the automated core needle biopsy device.
Results: Mammography was highly suggestive of malignancy or suspicious abnormalities in 17 cases whose histological findings from US-CNB specimens were invasive ductal carcinoma without exception. The other 14 cases with benign or probably benign mammography findings showed no malignancy histologically in the US-CNB specimens. In cases of malignancy, the accuracy rates of histological findings for the specimens obtained by US-CNB were 94.1% in histological type, 100% in direct infiltration, 82.4% in lymphatic infiltration, 82.4% in venous infiltration, 94.1% in histological grading and 82.4% in intraductal spread.
Conclusion: US-CNB was useful for making reliable preoperative histopathological diagnosis and may substitute fine needle aspiration biopsy and surgical biopsy.
|
INTRODUCTION |
|---|
|
TOPABSTRACTINTRODUCTIONPATIENTS AND METHODSRESULTSDISCUSSIONREFERENCES |
|---|
Histopathological diagnosis of breast cancer is mandatory before conducting surgery, although mammography and/or ultrasonography can afford fairly accurate diagnosis. In practice, fine needle aspiration cytology (FNAC) is applied to confirm the diagnosis of a breast tumor demonstrated by mammography and/or ultrasonography (1,2). FNAC, however, has some drawbacks, e.g. the tissue obtained could be insufficient for evaluation and a needle may fail to obtain tissue because of its flexibility. These drawbacks may lead to false negative findings (3,4). Consequently, FNAC remains unreliable when malignant cells are not found (5). Although surgical biopsy can afford sufficient material for diagnosis, it is not recommended because of the cost and the cosmetics. Parker et al. (6) reported the usefulness of ultrasound-guided core needle biopsy (US-CNB), but this procedure has not yet come into routine use. In this study, we conducted US-CNB to evaluate its usefulness as a preoperative diagnostic modality for breast cancer.
|
PATIENTS AND METHODS |
|---|
|
TOPABSTRACTINTRODUCTIONPATIENTS AND METHODSRESULTSDISCUSSIONREFERENCES |
|---|
US-CNB was performed in 31 consecutive patients whose breast tumors were visualized with ultrasonography between December 1997 and August 1998. The indication of US-CNB was solid and/or indeterminate breast lesions visualized with US.
The patients had received mammography, the findings of which were classified into three categories (benign, suspicious of malignancy and malignancy) according to both the guidelines of the American College of Radiology Breast Imaging Reporting and Data System [BI-RADS, 2nd edition (7)] (Table 1) and the US findings.
|
Biopsy was conducted using a ‘long-throw (2.3 cm excursion)’ automated biopsy gun (Biopsy TM, Bard Radiology, USA) fitted with a 16-gauge needle under the guidance of ultrasonography (LOGIC 700 MR TM, Yokokawa GE,USA) with a wide-band probe (6–13 MHz). After the skin had been anesthetized using 1% lidocaine, an anesthetic needle was directed to deposit anesthetic along the route through which the biopsy needle would pass. A small skin incision (2 mm) was made. The operator held the transducer in one hand and the needle in the other (a free-hand technique). The needle tip, which was continuously visualized on the display, was fired into the center of the tumor. Photo-documentation of the ultrasound image of the needle tip was recorded at both pre- and post-fire positions (Fig. 1). The needle was removed and the core sample was obtained. The specimen obtained was embedded in paraffin, cut into 4 µm sections and stained with hematoxylin–eosin. The histopathological findings for the biopsy specimens were compared with those of the resected specimens in cases where surgery was performed.
|
|
RESULTS |
|---|
|
TOPABSTRACTINTRODUCTIONPATIENTS AND METHODSRESULTSDISCUSSIONREFERENCES |
|---|
All patients were female with a mean age of 44.2 years (range, 16–70 years). The size of the tumor ranged from 7 to 45 mm (mean 22.5 mm).
The procedure for obtaining a specimen needed 5 min on average (range, 4–8 min). One specimen obtained by a single procedure of US-CNB was sufficient for histological examination in all cases.
According to the BI-RADS classification, 16 cases belonged to Category 5, one case to Category 4, four cases to Category 3 and 10 cases to Category 2 (Table 2). According to the classification by both MMG and US, 13 cases belonged to the benign classification, one case to suspicion of malignancy and 16 cases to malignancy. The histopathological diagnosis of biopsy specimens by US-CNB from 17 cases of Category 5 or 4 was invasive ductal cancer in all, without exception, and the other 14 cases, which were mammographically classified into Category 3 or 2, were benign disease. All 17 patients with invasive ductal cancer revealed by US-CNB underwent operation. Every surgically resected specimen was histopathologically confirmed to be invasive ductal cancer as diagnosed preoperatively by US-CNB. The accuracy rates of histological findings by US-CNB were 64.7% in histological type, 100% in direct infiltration to the adjacent fat tissue, 82.4% in lymphatic infiltration, 82.4% in venous infiltration, 94.1% in histological grading and 82.4% in intraductal components (Table 3).
|
|
US-CNB was completed with no serious complication. Two cases (6.5%) showed small hematoma, which subsided spontaneously and required no surgical drainage. The patients were able to return to work or activities of daily life on the day of US-CNB.
|
DISCUSSION |
|---|
|
TOPABSTRACTINTRODUCTIONPATIENTS AND METHODSRESULTSDISCUSSIONREFERENCES |
|---|
The goal of preoperative percutaneus needle biopsy (both FNAC and US-CNB) is to reduce the number of unnecessary open surgical biopsies. FNAC is the most popular technique. Major advantages of FNAC include its pinpoint accuracy, excellent tolerance by patients and ability to aspirate or inject fluid. FNAC can make a definite diagnosis when malignant cells are found, but it cannot indicate the histological character of the tumor (4). Disadvantages of FNAC include the risk for insufficient specimens, the inability to determine cancer invasiveness and the need for an expert cytopathologist.
Our results showed that the single use of US-CNB yielded sufficient material for histopathological diagnosis. US-CNB also offers substantial advantages over surgical biopsy (6). US-CNB has a very high tissue recovery rate in fibrous lesions, any pathologist can read the cores and the invasiveness of cancer can be determined.
US-CNB is not without difficulty and experience is needed to yield good results. Another disadvantage of US-CNB is the inability to aspirate fluid collections.
The cost of US-CNB is only one-quarter to half of that of surgical biopsy in the USA (8,9) US-CNB can be set up easily and performed more quickly without surgical scars. US-CNB was as successful as diagnostic surgical excisional biopsy in the correct histological diagnosis of the lesion (6). In cases of breast-conserving surgery, the information obtained from the US-CNB specimen is important. According to the grade of the intraductal components, the operative procedures (e.g. quadrantectomy or wide excision) were changed. The benign cases identified by US-CNB were followed without surgical biopsy. Patients who did not undergo surgical biopsy were followed up clinically, mammographically and ultrasonographically at 6 months and annually thereafter. In this study, the mean follow-up period was 14 months. However, no cases were revealed as cancer later. In this study, there were no false negative cases in the diagnosis of breast cancers. The reason why we use a ‘long-throw’ gun is to diagnose both direct infiltration to the adjacent fat tissue and the intraductal component.
The complication rate was low. Slight hematoma after puncture was encountered, which subsided spontaneously in a short time. All patients were able to return to work or the activities of daily life immediately after US-CNB. No adverse cosmetic results were observed after US-CNB as reported previously (6).
Because of these advantages, US-CNB may replace surgical biopsy and fine needle biopsy as a standard procedure for histological diagnosis of breast tumors.
|
FOOTNOTES |
|---|
+ For reprints and all correspondence: Takayuki Osanai, Second Department of Surgery, Tokyo Medical and Dental University, 1–5–45, Yushima, Bunkyo-ku, Tokyo 113-8519, JapanAbbreviations: US-CNB, ultrasound-guided core needle biopsy; FNAC, fine needle aspiration cytology; BI-RADS, Breast Imaging Reporting and Data System; MMG, mammography
|
REFERENCES |
|---|
|
TOPABSTRACTINTRODUCTIONPATIENTS AND METHODSRESULTSDISCUSSIONREFERENCES |
|---|
1 Martin EH, Ellis EB. Biopsy by needle puncture and aspiration. Ann Surg 1930;92:169–81.[Medline]
2 Azavedo E, Svane G, Auer G. Stereotactic fine-needle biopsy in 2594 mammographically detected non-palpable lesions. Lancet 1989;1:1033–6.[Web of Science][Medline]
3 Kopans DB. Fine-needle aspiration of clinically occult breast lesions. Radiology 1989;154:1196–7.
4 Masood S. Occult breast lesions and aspiration biopsy: a new challenge. Diagn Cytopathol 1993;9:613–4.[Web of Science][Medline]
5 Costa MJ, Tadros T, Hilton G, Birdsong G. Breast fine needle aspiration cytology: utility as a screening tool for clinically palpable lesions. Acta Cytol 1993;37:461–71.[Web of Science][Medline]
6 Parker SH, Jobe WE, Dennis MA, Stavros AT, Johnson KK, Yakes WF, et al. US-guided automated large-core breast biopsy. Radiology 1993;187:507–11.
7 American College of Radiology. Breast Imaging Reporting and Data System (BI-RADS), 2nd ed. Reston, VA: American College of Radiology 1995.
8 Hall FM, Storella JM, Silverstone DZ, Wyshak G. Nonpalpable breast lesions: recommendations for biopsy based on suspicion of carcinoma at mammography. Radiology 1988;167:353–8.
9 Liberman L, Fahs MC, Dershaw DD, Bonaccio E, Abramson AF, Cohen MA, et al. Impact of stereotaxic core breast biopsy on cost of diagnosis. Radiology 1994;195:633–7.
Received September 9, 1999; accepted October 26, 1999.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||